Last update Sept. 7, 2022

Glyceryl Trinitrate

Likely Compatibility

Fairly safe. Mild or unlikely adverse effects. Compatible under certain circumstances. Follow-up recommended. Read Commentary.

Glyceryl nitrate or trinitrate or nitroglycerin is a vasodilator used to treat cardiac disorders like ischemia and mainly anal fissures. It is also used during pregnancy as a tocolytic drug in cases of threatened preterm labor and eclampsia (Kashanian 2014, Conde 2013). It is administered intravenously, orally, sublingually, on skin patches, ointment ...

Since the last update we have not found published data on its excretion in breastmilk.

Because of a high volume of distribution and very fast metabolism (Tmax and T1/2 of a few minutes) it is highly unlikely the passage of significant amounts to the breast milk (Kearney 2018), especially when applied topically. This explains why it has not been observed any troubles in 40 infants whose mothers with anal fissures were treated with nitroglycerin ointment application even for periods of 12 months. Mothers have complained of headaches that commonly occur with the use of various vasodilators drugs. (Taylor 2008)

The amount of nitrate / nitrite in this type of vasodilator drugs is of few milligrams, therefore, toxicity associated to nitrates such as methemoglobinemia in breastfed infants from treated mothers has not been reported (The dose of nitrite is Rectogesic 1.5 mg / 12 hours).

It has been used to treat heart disorders in babies and children; even to treat anal fissures in children under 1 year, and noteworthy, in ischemic issues on premature infants, without side effects. (Samiee 2014, Mosalli 2013, Vasquez 2003, Kenny 2001, Wong 1992)

Although it has been used topically to treat Raynaud's phenomenon of the nipple (O'Sullivan 2011), nitroglycerin should not be used topically on the nipples during breastfeeding to prevent it from being taken by the infant.

Alternatives

  • Nifedipine (Safe substance and/or breastfeeding is the best option.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

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Other names

Glyceryl Trinitrate is also known as


Glyceryl Trinitrate in other languages or writings:

Groups

Glyceryl Trinitrate belongs to these groups or families:

Tradenames

Main tradenames from several countries containing Glyceryl Trinitrate in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 30 %
Molecular weight 227 daltons
Protein Binding 60 %
VD 3 l/Kg
Tmax 0.03 - 0.3 hours
T½ 0.2 - 0.07 hours

References

  1. Kearney L, Wright P, Fhadil S, Thomas M. Postpartum Cardiomyopathy and Considerations for Breastfeeding. Card Fail Rev. 2018 Abstract Full text (link to original source) Full text (in our servers)
  2. Kashanian M, Zamen Z, Sheikhansari N. Comparison between nitroglycerin dermal patch and nifedipine for treatment of preterm labor: a randomized clinical trial. J Perinatol. 2014 Abstract
  3. Samiee-Zafarghandy S, van den Anker JN, Ben Fadel N. Topical nitroglycerin in neonates with tissue injury: A case report and review of the literature. Paediatr Child Health. 2014 Abstract Full text (link to original source) Full text (in our servers)
  4. Mosalli R, Elbaz M, Paes B. Topical Nitroglycerine for Neonatal Arterial Associated Peripheral Ischemia following Cannulation: A Case Report and Comprehensive Literature Review. Case Rep Pediatr. 2013 Abstract Full text (link to original source) Full text (in our servers)
  5. Conde-Agudelo A, Romero R. Transdermal nitroglycerin for the treatment of preterm labor: a systematic review and metaanalysis. Am J Obstet Gynecol. 2013 Abstract
  6. O'Sullivan S, Keith MP. Raynaud phenomenon of the nipple: a rare finding in rheumatology clinic. J Clin Rheumatol. 2011 Abstract
  7. Taylor T, Kennedy D. Safety of topical glyceryl trinitrate in the treatment of anal fissure in breastfeeding women. Birth Defects Research Part a-Clinical and Molecular Teratology. 2008;82:411. Abstract. 2008 Abstract Full text (link to original source) Full text (in our servers)
  8. Vasquez P, Burd A, Mehta R, Hiatt M, Hegyi T. Resolution of peripheral artery catheter-induced ischemic injury following prolonged treatment with topical nitroglycerin ointment in a newborn: a case report. J Perinatol. 2003 Abstract Full text (link to original source) Full text (in our servers)
  9. Kenny SE, Irvine T, Driver CP, Nunn AT, Losty PD, Jones MO, Turnock RR, Lamont GL, Lloyd DA. Double blind randomised controlled trial of topical glyceryl trinitrate in anal fissure. Arch Dis Child. 2001 Abstract Full text (link to original source) Full text (in our servers)
  10. Kirsten R, Nelson K, Kirsten D, Heintz B. Clinical pharmacokinetics of vasodilators. Part II. Clin Pharmacokinet. 1998 Abstract
  11. Dusdieker LB, Stumbo PJ, Kross BC, Dungy CI. Does increased nitrate ingestion elevate nitrate levels in human milk? Arch Pediatr Adolesc Med. 1996 Mar;150(3):311-4. Abstract
  12. Wong AF, McCulloch LM, Sola A. Treatment of peripheral tissue ischemia with topical nitroglycerin ointment in neonates. J Pediatr. 1992 Abstract
  13. Paszkowski T, Sikorski R, Kozak A, Kowalski B, Jakubik J. [Contamination of human milk with nitrates and nitrites]. Pol Tyg Lek. 1989 Nov 13-27;44(46-48):961-3. Polish. Abstract

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